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Strengthening Global Health Security by Embedding the International Health Regulations Requirements Into National Health Systems

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Strengthening Global Health Security by Embedding the International Health Regulations Requirements Into National Health Systems Analysis BMJ Glob Health: first published as 10.1136/bmjgh-2017-000656 on 20 January 2018. Downloaded from Strengthening global health security by embedding the International Health Regulations requirements into national health systems Hans Kluge,1 Jose Maria Martín-Moreno,2 Nedret Emiroglu,3 Guenael Rodier,4 Edward Kelley,5 Melitta Vujnovic,6 Govin Permanand7 To cite: Kluge H, ABSTRACT As the leading global organisation with Martín-Moreno JM, Emiroglu N, The International Health Regulations (IHR) 2005, as the responsibility for health governance, WHO et al. Strengthening global overarching instrument for global health security, are has bore the brunt of the criticism.5–7 health security by embedding designed to prevent and cope with major international the International Health Depending on the crisis, accusations have public health threats. But poor implementation in countries Regulations requirements hampers their effectiveness. In the wake of a number of ranged from responding too slowly or in ad into national health hoc fashion, to over-reacting and fear-mon- systems. BMJ Glob Health major international health crises, such as the 2014 Ebola 2018;3:e000656. doi:10.1136/ and 2016 Zika outbreaks, and the findings of a number gering, as well as not learning lessons and bmjgh-2017-000656 of high-level assessments of the global response to these not making necessary structural and organ- crises, it has become clear that there is a need for more isational reforms. Proposals for taking the Handling editor Seye Abimbola joined-up thinking between health system strengthening health security agenda forward have thus activities and health security efforts for prevention, alert included reaffirming and strengthening Received 23 November 2017 and response. WHO is working directly with its Member Revised 18 December 2017 States to promote this approach, more specifically around WHO’s central role and the need to better Accepted 19 December 2017 how to better embed the IHR (2005) core capacities resource the organisation, to removing into the main health system functions. This paper looks emergency response from WHO’s purview, at how and where the intersections between the IHR and even setting up a new body entirely.8 9 and the health system can be best leveraged towards Against the backdrop of such debate, WHO 1Health Systems and developing greater health system resilience. This merging continues to implement a wider reform of approaches is a key component in pursuit of Universal http://gh.bmj.com/ Public Health, World Health process which, since Ebola, includes emer- Organization Regional Office for Health Coverage and strengthened global health security as two mutually reinforcing agendas. gency capacities and work in promoting Europe, Copenhagen, Denmark i 2Preventive Medicine and Public global health security . Health and University Clinical Central to these discussions are the Interna- Hospital INCLIVA, University of BACKGROUND tional Health Regulations (IHR), which have Valencia, Valencia, Spain In today's increasingly interconnected and 3 been at the heart of the global health security on September 27, 2021 by guest. Protected copyright. Communicable Diseases and Health Security, World Health interdependent world, where people, goods agenda since 1969 (preceded by the Interna- Organization Regional Office for and services move easily across borders, it tional Sanitary Regulations from 1951). The Europe, Copenhagen, Denmark is more important than ever to ensure that IHR aim to prevent, protect against, control 4Country Health Emergency countries are able to respond in timely and and provide a response to public health Preparedness and IHR, World effective fashion to contain, and indeed Health Organization, Geneva, threats through improved surveillance, prevent, threats to public health.1–3 Recent Switzerland reporting and international cooperation, and 5 global health crises, including H1N1 influ- Service Delivery and Safety, to do so in ways which avoid unnecessary inter- World Health Organization, enza (2009), Ebola (2014) and Zika (2016) ference with international traffic and trade.10 Geneva, Switzerland have resulted in pointed criticisms of the 6 World Health Organisation international health community’s ability to Today, the IHR (2005) represent a binding Representative, Moscow, deal with such threats. But crises also offer instrument on the 196 ‘States Parties’, on Russian Federation whom rest responsibility for acquiring the 7Health Systems and opportunities for learning and improvement. Public Health, World Health An important result of such criticism has core capacity for surveillance and response Organization Regional Office for been an incremental strengthening of inter- required under the IHR (2005) and for overall Europe, Copenhagen, Denmark national resolve and know-how to promote adherence to the Regulations, although their Correspondence to and improve global health security (covering Dr Govin Permanand; both individual and collective health security i See http://www.who.int/about/who_reform/en/ for 4 permanandg@ who. int at global/international level ). more information. Kluge H, et al. BMJ Glob Health 2018;3:e000656. doi:10.1136/bmjgh-2017-000656 1 BMJ Global Health BMJ Glob Health: first published as 10.1136/bmjgh-2017-000656 on 20 January 2018. Downloaded from to national health systems, rather than seen as a top-down Key questions set of externally imposed stipulations. What is already known about this topic? In making the case for better embedding the IHR into national health systems in pursuit of Universal Health ► There is little known and very little, if any, published on this topic. ► Despite being legally binding on all International Health Coverage (UHC), this paper outlines the need for more Regulations (IHR) States Parties (which include all 194 WHO joined-up thinking between the IHR core capacities and Member States), the IHR (2005) core capacity requirements have health system functions. It provides a brief outline of the been poorly implemented in most countries, particularly in those IHR before focusing on a number of important intersec- that are resource-poor and vulnerable. tions with health systems and showing where they can be ► This deficit in awareness and implementation, highlighted in the built on. In closing, we touch on actions that WHO is aftermath of the 2014 Ebola and 2016 Zika epidemics, has only taking to increase its effectiveness in this area and stress recently been brought to the attention of the global public health the importance of strong health systems for delivering community with the understanding that IHR (2005) core capacities IHR commitments. The aim is to identify a number of are an integral part of the essential public health functions and key issues in order to prompt discussion about health need to be embedded into the health system functions. systems and global health security in general, as well as What are the new findings? WHO’s role and the IHR. ► That health system strengthening and health security efforts for prevention, alert and response need to be pursued in tandem, as part of the same mutually reinforcing approach to developing THE INTERNATIONAL HEALTH REGULATIONS: WORKING FOR resilient health systems, is a new understanding. GLOBAL HEALTH SECURITY ► There is now a demonstrated need to embed the IHR (2005) Following the Severe Acute Respiratory Syndrome crisis core capacities into health systems, across the six health system of 2003, the international community agreed to improve functions, where the leadership and governance function is probably the most important to improving IHR implementation and the detection, reporting and response to potential public pursuing Universal Health Coverage (UHC). health emergencies worldwide. This required re-evalu- ► UHC supports health security (eg, preventing outbreaks through ating the existing IHR (1969), which was a framework for high immunisation coverage, providing early alert by rapid access reporting only three infectious diseases: cholera, plague of all patients to healthcare, better response thanks to reliable and yellow fever (smallpox was removed in 1981 following infrastructure and healthcare workforce for case management, etc), its official eradication in 1980). The result was a new while health security investment supports UHC by avoiding health articulation of the IHR in 2005 that widened the scope crises that prevent patients accessing healthcare (eg, a health of coverage to include all events (including chemical and workforce diverted from regular care to focus on crisis response, or nuclear hazards) that could lead to Public Health Emer- is itself victim of the crisis as seen during Severe Acute Respiratory gencies of International Concern (PHEIC). The revised Syndrome, influenza pandemics, Ebola, etc; or patients’ fear of IHR (2005) came into force in 2007. contamination sees them avoid regular care seeking). In 2009, in the aftermath of the H1N1 influenza ► Understanding this mutual reinforcement and the urgent need for http://gh.bmj.com/ joint work and synergy between health system strengthening and pandemic, WHO’s Executive Board convened an inde- 12 health security efforts is a new concept. pendent review of the effectiveness of the IHR (2005). The review highlighted a number of positives but Recommendations for policy concluded that more was required for the world to ► Close coordination between the health system and health security respond adequately to sustained public health emer-
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